Hip Fracture: Symptoms, Types, Causes and Treatment

Hip fractures are among the most serious injuries affecting adults, especially older individuals. Not only do they lead to significant pain and loss of mobility, but they can also profoundly impact a person’s overall health and wellbeing. Understanding the symptoms, types, causes, and treatment options is crucial for patients, families, and healthcare professionals. This comprehensive article synthesizes the latest evidence to provide a detailed, practical guide on hip fractures.

Symptoms of Hip Fracture

Hip fractures usually present suddenly, often after a fall or trauma, and can quickly lead to complications if not recognized and treated promptly. Early recognition of symptoms allows for faster intervention, reducing the risk of further health deterioration and improving recovery prospects.

Main Symptom	Description	Additional Features	Source(s)
Pain	Sudden, severe hip/groin pain	Worsened by movement, weight-bearing impossible	6 10
Immobility	Inability to walk or stand	Leg may appear shortened or rotated	6 10
Swelling	Localized to hip/thigh	May be accompanied by bruising	6 10
Psychological	Depression, distress	May occur post-injury, affecting recovery	1

Table 1: Key Symptoms

Understanding the Symptoms

The classic presentation of a hip fracture is acute pain in the hip or groin area, often after a low-energy fall, especially in older adults. This pain typically makes it impossible for the person to stand or bear weight on the affected leg. Sometimes, the injured leg may appear shorter and turned outward compared to the other leg—a telltale sign of a displaced fracture 6 10.

Pain and Physical Signs

• Location: Most patients describe pain deep in the groin or over the outer upper thigh.
• Movement: Any attempt to move, stand, or walk intensifies the pain.
• Visual Signs: Swelling and bruising often develop rapidly. The affected leg may look shorter or abnormally rotated.

Immobility and Loss of Function

Immobility is a hallmark symptom. Even minimal movement is difficult or impossible, and patients may need help even to adjust in bed. This immobility can set off a cascade of complications, such as blood clots, bedsores, and pneumonia, especially in the elderly 10.

Psychological and Emotional Symptoms

Aside from the immediate physical effects, hip fractures can have psychological impacts. Some individuals develop depressive symptoms or anxiety during recovery, particularly if mobility is slow to return. Factors such as poor social support or previous mental health issues may increase this risk 1.

Types of Hip Fracture

Not all hip fractures are the same. The location, pattern, and context of the fracture play a vital role in determining the appropriate treatment and prognosis. Understanding the main types can help demystify the clinical approach to this serious injury.

Type	Location/Pattern	Common in	Source(s)
Intracapsular	Within hip joint capsule (femoral neck)	Elderly, after falls	6 9 10
Extracapsular	Outside joint capsule (intertrochanteric, subtrochanteric)	All ages, high/low trauma	6 10
Periprosthetic	Around hip prosthesis	Post-arthroplasty patients	2 3 5
Special types	Fracture-dislocation, liner fracture	After THA, rare cases	7 11

Table 2: Types of Hip Fracture

Breaking Down the Types

Intracapsular Fractures

These occur within the capsule of the hip joint, most commonly at the femoral neck. They are particularly significant because they risk disrupting the blood supply to the femoral head, increasing the chance of complications such as avascular necrosis (bone death) 6 9 10.

• Displaced vs. Non-Displaced: Displacement means the bone fragments have shifted, often requiring more complex treatment.

Extracapsular Fractures

These include intertrochanteric and subtrochanteric fractures, which lie outside the joint capsule.

• Intertrochanteric: Between the greater and lesser trochanter (bony prominences).
• Subtrochanteric: Just below the lesser trochanter.

These types tend to have a better blood supply, so healing is often more predictable 6 10.

Periprosthetic Fractures

Periprosthetic fractures occur around an existing hip prosthesis, such as after total hip arthroplasty (THA). These fractures are increasingly common as more people undergo hip replacements and live longer 2 3 5.

• Classification: Multiple systems exist for classifying these fractures, often based on location and stability of the implant 2 5.

Special Types

• Fracture-Dislocation: Complex injuries involving both fracture and joint dislocation, usually after high-energy trauma or failed previous surgery 11.
• Liner Fracture: Occurs in ceramic-on-ceramic THA, where the liner within the prosthesis cracks, usually due to implant malposition or trauma 7.

Causes of Hip Fracture

Understanding why hip fractures happen is essential for both prevention and effective treatment. The causes are multifactorial, involving both patient-related and external factors.

Cause	Description	Risk Factors	Source(s)
Trauma	Falls (especially in elderly)	Age, osteoporosis, frailty	6 10
Prosthesis-related	During/after hip replacement surgery	Implant type, surgical technique	2 3 4 5
Bone disease	Osteoporosis, bone weakening	Chronic conditions, medications	6 10
Other Factors	Smoking, depression, comorbidities	Psychosocial status, comorbidities	1 5

Table 3: Causes of Hip Fracture

Exploring the Causes

Falls and Trauma

The overwhelming majority of hip fractures in older adults result from low-energy falls, such as slipping or tripping at home. In younger individuals, higher-energy trauma, such as vehicle accidents, is more common 6 10.

Bone Health and Osteoporosis

Osteoporosis—a condition in which bones become fragile and more likely to break—is a leading underlying factor. Chronic illnesses and certain medications can also weaken bone, making fractures more likely even with minor trauma 6 10.

Surgery and Prosthesis-Related Factors

With the increasing prevalence of hip replacements, fractures can occur during or after surgery (intraoperative or periprosthetic fractures). Risk factors include:

• Implant Type: Cementless implants carry a higher risk of intraoperative fracture compared to cemented ones 2 4.
• Surgical Technique: Non-posterior approaches, poor implant positioning, and lack of computer guidance can increase risk 4.
• Previous Surgery: Revisions and multiple surgeries further weaken bone, increasing fracture risk 3 5.

Patient-Specific and Psychosocial Factors

Other contributors include:

• Age and Sex: Both very young (<50 years, typically from trauma) and older (>80 years) adults are at higher risk. Females are more affected than males 4.
• Comorbidities: Chronic illnesses, smoking, and even psychological stress or depression can increase vulnerability and worsen outcomes 1 5.
• Medication Use: Some medications, such as corticosteroids, can weaken bones over time.

Treatment of Hip Fracture

Treating hip fractures is complex and must be tailored to each individual. The ultimate goals are to relieve pain, restore mobility, and prevent complications. Treatment options continue to evolve as research provides new insights.

Treatment	Approach	Indication/Benefits	Source(s)
Surgery	Osteosynthesis, arthroplasty (THA/HA), internal fixation	Restores mobility, reduces mortality	6 8 9 10
Revision/ORIF	For periprosthetic or complex fractures	Depends on fracture type, patient status	3 5 7 11
Multidisciplinary	Geriatric, medical, psychosocial support	Improves outcomes, addresses comorbidities	1 10
Rehabilitation	Physical therapy, home support	Promotes recovery, prevents complications	10

Table 4: Treatment Options

Surgical Management

Osteosynthesis

This involves mechanically fixing the broken bone with screws, plates, or rods. It is most suitable for certain extracapsular and non-displaced intracapsular fractures 6 10.

Arthroplasty: Hemiarthroplasty (HA) vs. Total Hip Arthroplasty (THA)

• Hemiarthroplasty (HA): Replaces the femoral head while preserving the natural socket. Common in older adults with lower functional demands 8 9 12.
• Total Hip Arthroplasty (THA): Replaces both the femoral head and the acetabular socket. Increasingly used in adults with higher pre-fracture mobility and independence 8 9 12.

Evidence Comparison

• Function & Mobility: THA often results in slightly better function and less pain than HA, especially in active individuals 8 9.
• Complications: THA is associated with higher rates of hip-specific complications (e.g., dislocation) but fewer medical complications and possibly lower mortality in some studies 8 9 12.
• Cost-effectiveness: THA may be more cost-effective over the long term due to reduced revision rates, despite higher initial costs 9.
• Surgical Risks: Both procedures carry risks; surgical decision-making should be individualized.

Revision Surgery and ORIF

For periprosthetic fractures (those occurring around hip prostheses), treatment options include:

• Revision Arthroplasty (RA): Replacing the old prosthesis, often indicated when the implant is loose or fracture is complex.
• Open Reduction Internal Fixation (ORIF): Stabilizing the fracture with hardware without replacing the prosthesis, suitable for certain fracture patterns 3 5 7 11.

Outcomes depend on the fracture type, patient age, comorbidities, and overall functional status. Revision arthroplasty tends to yield better functional outcomes in selected patients 5 11.

Multidisciplinary and Supportive Care

Hip fracture management doesn’t end with surgery. Optimal outcomes require a coordinated approach:

• Orthogeriatric Care: Joint care by orthopedic surgeons and geriatricians improves medical management and reduces complications 10.
• Early Surgery: Operating within 24-48 hours reduces mortality and improves function 10.
• Pain Control and Nutrition: Adequate pain management and addressing malnutrition are essential for recovery 10.
• Psychosocial Support: Early identification and treatment of depression or anxiety can improve rehabilitation participation and outcomes 1.

Rehabilitation

Physical therapy starts as soon as medically safe, focusing on restoring mobility, balance, and independence. Home-based rehabilitation and safe discharge planning are critical to prevent falls and hospital readmissions 10.

Conclusion

Hip fractures are a major health challenge, particularly in older adults. Prompt recognition, accurate classification, understanding of underlying causes, and evidence-based treatment are all essential for optimal recovery. The management of hip fractures continues to evolve, with a growing emphasis on multidisciplinary care and personalized treatment strategies.

Key Takeaways:

• Hip fractures typically cause sudden pain, immobility, and visible changes in leg appearance. Psychological distress may also occur 1 6 10.
• Main types include intracapsular, extracapsular, periprosthetic, and special forms like liner fractures 2 3 6 7 9 10 11.
• Causes range from falls and osteoporosis to surgical complications and comorbid factors like smoking or depression 1 2 3 4 5 6 10.
• Treatment is usually surgical, with options tailored to fracture type and patient status; multidisciplinary care and rehabilitation are vital for recovery 1 3 5 6 8 9 10 11 12.
• Ongoing research is improving our understanding of optimal surgical techniques, rehabilitation strategies, and the importance of addressing mental health in recovery 1 10.

Understanding hip fractures in all their complexity is vital for reducing their impact on individuals and society. With continued advances in care and prevention, outcomes for patients can keep improving.